Provider Demographics
NPI:1740429703
Name:CENTRAL PARK PODIATRY PC
Entity Type:Organization
Organization Name:CENTRAL PARK PODIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHVETS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:914-337-4900
Mailing Address - Street 1:2172 CENTRAL PARK AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-1826
Mailing Address - Country:US
Mailing Address - Phone:914-337-4900
Mailing Address - Fax:914-337-5228
Practice Address - Street 1:2172 CENTRAL PARK AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-1826
Practice Address - Country:US
Practice Address - Phone:914-337-4900
Practice Address - Fax:914-337-5228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-16
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
213EP1101X, 213ES0131X
NYN004812213ES0000X, 213ES0103X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Multi-Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Multi-Specialty
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports MedicineGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP08782OtherEMPIRE
NYP672271OtherOXFORD
NY1C5826OtherHEALTHNET
W0P121Medicare PIN
NYP672271OtherOXFORD
NYA100000923Medicare PIN